Tuesday, October 30, 2012

The Choice
Lab at the Norwegian School of Economics (NHH) and the Rady School of Management at UC San Diego will host a
spring school in behavioral economics. The goal of this spring school is to
introduce graduate students to new and exciting research in the field. This
is a great opportunity for graduate students to expand their behavioral skills
and learn what behavioral economics research is about. Topics include social preferences, (psychological) games, incentives,
charitable giving and behavioral interventions.

The Summer School is comprised of a
series of 10 half day lectures. The lectures will be delivered by Jim Andreoni, Alexander Cappelen, Martin Dufwenberg, Armin Falk, Uri
Gneezy, Theo Offerman, Bertil Tungodden, Lise Vesterlund and Angelino Viceisza.
A strong emphasis is given to informal interactions, and students will also be
given the opportunity to present their work.

We will
cover participants’ costs during the workshop, including housing and most
meals. Unfortunately, we do not have funds to cover travel costs. About twenty
five participants will be invited.

To apply,
please send your curriculum vitae and a short (up to 1000 words) statement of
research interest, all in one pdf file to rady.spring.school@gmail.com. We will also need a letter of recommendation to be sent to the same
email address. The deadline for applications is Monday, December 31, 2012.

Monday, October 29, 2012

Modeling a marketplace involves leaving out a lot of things that can actually happen in the market. People who work with models know this, but I'm constantly reminded by events just how rich a world it is that we try to model as simply as we can. Take the case of New York City's elite exam schools, and Hurricane Sandy.

New York's exam schools, such as Stuyvesant and Bronx Magic (as the august Bronx High School of Science used to be called when I was in junior high) admit students on the basis of scores on the Specialized High School Admissions Test (SHSAT). So the exams are very high stakes for the very young scholars who take them, and many students engage in extensive test preparation (see e.g. this story).

The exams were scheduled for this past weekend: some students would take them on Saturday and some on Sunday. But the approach of Hurricane Sandy caused the Sunday exam to be rescheduled to November 18, three weeks later than originally scheduled, and three weeks later than the students who took the exam as scheduled on Saturday. This caused some distress to at least some parents who (because of recent news stories) emailed me. One was concerned that even some students who were scheduled to take the exam on Saturday may have contrived to get three more weeks of preparation:

"Those who thought to have more prep time for SHSAT opted to be absent today and using doctor's note to gain 3 weeks study time. I guess human nature always try to game the system.
"Inherent problem of NYC DOE system is that a student can take this test only once. It is so high stake that some family try to game it. I guess algorithm can not factor in this."

Sunday, October 28, 2012

The Nobel committee recognized two Stanford faculty members this year. And it's the football season.
So here I am, waving to the crowd from the field, with Brian Kobilka, who shared this year's Nobel prize in Chemistry. (The bottom pic is how we looked to my wife from the skydeck of Stanford's football stadium...)

Saturday, October 27, 2012

"Pakistan's supreme court has ordered authorities to investigate the alleged barter of 13 children - all girls - to settle a blood feud in a remote area of the southwestern Balochistan province.
...
"Saeed Faisal, the deputy commissioner for the district, told the court that a tribal council had ordered the barter in early September.

"Faisal said that he did not know the girls' ages, but local media reported that they were aged between four and 13.
...
"Wani, the tradition of families exchanging unmarried girls to settle feuds, is banned under Pakistani law but still practiced in the country's more conservative and tribal areas."

Friday, October 26, 2012

The phrase "מוסר כליות" (musar claiot) in Hebrew could be literally translated as "kidney ethics," but is an idiom that means something like "a guilty conscience" or maybe "remorse". It's the headline of this story in Haaretz magazine, about the grey market for organs in Israel...

Wednesday, October 24, 2012

Deceased donor organs in the United States are allocated through regional (not national) waiting lists, which leads to some dramatic differences in e.g. waiting times in different parts of the country. Individual candidates for transplantation can register as patients in different regions, if they are healthy and wealthy enough to move around. (e.g. Steve Jobs received a liver in Memphis, although I recall he worked at a company located in California...) He had access to good transportation opportunities.

Monday, October 22, 2012

An article in Haaretz describes the market for kidneys ("kidney bazaar" בזאר הכליות) in Iran, and includes this picture of ads written on a wall in Tehran.

"Qasemi Mustafa, head of Kidney Patients Support Association in Iran, said the average sum received by the donors ranged around $ 6,000 [paid by the recipient]. The Government adds that another thousand dollars."

"Iran is the only country where the selling and buying of kidneys is legal. As a result, there is no shortage of the organs – but for those trying to sell a kidney, there is a lot of competition.
...
"Competition means that some ads have been torn down. Some have added their information to ads by other donors. Others have placed their ads on people's doors or simply written them in marker pen on trees where they think they will catch people's attention.

"At the heart of the capital, near the Charity Association for the Support of Kidney Patients (CASKP), the number of ads has made the streets of Tehran into a sort of kidney eBay.
...
"Iran's controversial kidney procurement system, which has been praised by many experts and criticised by others, allows people to sell and buy kidneys under the state-regulated surveillance of two non-profit organisations, the CASKP and the Charity Foundation for Special Diseases. These charities facilitate the process by finding potential vendors and introducing them to the recipients, and are charged with checking the compatibility of a possible donation and ensuring a fair trade.

"After the transplant, the vendor is compensated by both the government and the recipient. In an interview with the semi-official Mehr news agency, the CASKP's director, Mostafa Ghassemi, estimated the total official price list to be around 7m rials, of which 1m is paid by the government. Iranians are not allowed to donate kidneys to non-citizens.

"In 2010, a total of 2,285 kidney transplants took place in the country, of which 1,690 kidneys were supplied from volunteers and 595 from those clinically brain-dead," he said. According to Mehr, the majority of people selling kidneys are aged 20-30. Despite the state control, bureaucracy and time-consuming procedures have left the door open for non-official direct negotiations, making the Iranian system more like a kidney market.

"Dr Benjamin Hippen, a transplant nephrologist with the Carolinas medical centre in North Carolina, US, has studied successes, deficiencies and the ambiguities of the Iranian system.

"Making a judgment about whether the 20-year-old system as a whole has been successful was complicated, he said. "The majority of those selling kidneys in Iran are disproportionately poor, and information about the long-term outcomes for sellers is quite limited. Too, it is increasingly clear that there are many different systems, rather than a single unified system in Iran.

"That said, Iran appears to have successfully addressed the shortage of organs, incentives for organs have not substantially attenuated the growth and development of organ procurement from deceased donors, and reported outcomes for recipients have been favourable."

"Comparing Iran with Pakistan, where organ trafficking is nominally illegal but still occurs, Hippen, who is an associate editor of the American Journal of Transplantation, said: "It seems to me that if Iran had not developed a system of incentives, the situation there today would look very much like the state of affairs in countries such as Pakistan."

"In the US, more than 100,000 people were estimated to be on the waiting list for kidney transplants in 2010 – waiting lists were eliminated in Iran in 1999.

"Hippen has pointed out that "since 1999, more than 30,000 US patients with kidney failure have died waiting for an organ that never arrived".

"Arguing in favour of allowing people to sell their kidneys, Sue Rabbitt Roff, a senior research fellow at the University of Dundee, said last year that it was time to "pilot paid provision of live kidneys in the UK under strict rules of access and equity".

Thursday, October 18, 2012

This story of kidney exchange in India reminds me of the early days in the U.S., before there was a thick marketplace. (In addition it sounds as if Indian laws make exchange difficult, no doubt with the intention of making difficult the cash-for-kidneys black market...)

""Both the patients had approached us separately. They had come along with
came individually with their respective wives as probable donors. But the
transplants could not take place at that time as the blood groups of the
patients and that of their respective wives did not match," said Dr Deepak
Shankar Ray, the head of nephrology at RTIICS.

"Later, while scanning through the list of renal failure patients with renal
failures and their prospective donors (related) who had come to the hospital,
Ray happened to stumbled upon the fact that Manoj Kumar's blood group which is A
+matched that of Umesh Prasad.

"Gupta's wife's, while Gupta's blood group
was the same as which is B + matched that of Kumar's wife. While Nandarani and
Gupta are B+, Kumar and Reena are both A+. The doctor then acted as a link
between the two parties informing them that the transplants could happen if
their wives were ready to donate their kidneys to someone else.
...
"Armed with no-objection certificates from the health department of their
respective states (mandatory under the Organ Transplant Act), the patients came
back returned to Kolkata a few weeks back.

"In Kolkata, advocate Subhomoy Samajddar filed affidavits at Alipore court
that is required for unrelated donor transplant. The court has granted
permission and we will forward all documents to the state health department next
week that will complete all the legal formalities," said Sumato Ghosh, the legal
manager at RTIICS."

Wednesday, October 17, 2012

Kidney exchange isn't just about the technology of matching and the logistics of arranging many surgeries, or difficult ones, it is also about the intensely personal stories of donors and recipients. The news stories below open a window on some of those, from Vancouver British Columbia. to San Antonio Texas

Backing out was never an option for B.C. donor
"I was the last in the chain to do the donation," said Campbell, 48, of Qualicum Beach, B.C., who was scheduled to give one of her kidneys to a Montreal man days after her husband Steve got a kidney from an Ottawa donor. Organizers asked her repeatedly whether she would honour her commitment no matter what happened on the operating table to her husband, she recalled.

"'And what happens if Steve doesn't do well, will you still be able to get on a plane and go?' They put a lot of faith in me not backing out."

Well, I had an unusual day yesterday. But I'm not much further along digesting it. So I think I'll go back to usual (non Nobel) blogging about market design. I'm still working on answering emails, 'tho I'm sure to miss some, or give up before I get to the earliest ones. But I appreciate all the well wishes...

Monday, October 15, 2012

Sunday, October 14, 2012

The venerable Onion has a competitor in the sometimes pretty funny New England Journal of Medicine, which notes the correlation between national chocolate consumption and per-capita Nobel prizes.And the Swiss eat a lot of chocolate. Slate has the story:

"A new study in The New England Journal of Medicine shows that a country's chocolate consumption correlates strongly with the number of Nobel Prizes its citizens win. According to the author’s calculations, Switzerland consumes the most chocolate and ranks second behind Sweden in laureates per capita. ...Switzerland doesn’t have the climate to grow cocoa. How did it become known for chocolate?

"Because the great chocolate innovators were Swiss. ... In 1819, Francois-Louis Cailler developed a recipe to turn gritty cocoa beans into a solid, smooth chocolate bar. Rudolph Lindt eventually perfected the smoothing process by adding cocoa butter with a machine he called the conche. In 1830, his countryman Charles-Amédée Kohler added hazelnuts to chocolate. Jean Tobler formulated the Toblerone bar in the late 1860s. Perhaps the greatest innovation came in 1875, when Daniel Peter figured out how to combine cocoa powder with local milk to create milk chocolate, which became an instant sensation. (The Swiss can’t take credit for cocoa powder, which was developed by Dutch chemist Coenraad J. van Houten in 1828.) Eventually, Kohler, Peter, and food magnate Henri Nestlé joined forces to create the Swiss Chocolate Society, which eventually became the Nestlé company. Today, Swiss consumers eat more than 23 pounds of the country’s most famous product per year.

"There’s another factor to Switzerland’s high chocolate consumption: wealth. (Which may also explain the correlation with Nobel prizes.) Few cocoa-producing countries are big chocolate consumers, because chocolate is a luxury. Ivory Coast, Indonesia, Ghana, and Nigeria, all of which have per capita GDPs well below the global average, lead the world in cocoa production. By contrast, wealthy Western Europe constitutes 6 percent of the world’s population, but eats 45 percent of its chocolate."

Friday, October 12, 2012

"Two Texas mothers set off a firestorm recently when they complained that a male assistant principal had severely paddled their daughters. One of the mothers pointed out that school policy required that officials of the same sex as the student do the paddling. Now the school board has responded — by dropping the rule requiring paddlers and students to be of the same sex.

Thursday, October 11, 2012

We have a new championship pair in the World Wife Carrying Championships in Finland, and they are the old champions. (I like wife carrying because it's similar enough to dwarf tossing to raise the question about why one is widely repugnant and the other is not...).

The basic story is that all the production of sugar beets in Denmark get sold
to a monopsonist firm Danisco, and at the start of the year each farmer buys
rights to sell a certain quantity of beets to Danisco at harvest, based on
their production estimates. Often when harvest comes farmers end up
wanting to buy or sell rights, however in the past this has been difficult to
do in a centralized fashion because a double auction for rights would reveal
too much information to Danisco and enhance its bargaining power versus the
farmer's association. Recently they instituted a system where they could
essentially submit their bids in encrypted form to an algorithm that can
compute the market clearing price and exchanges without needing to decrypt
individual bids.

Tuesday, October 9, 2012

There are two things underlying school choice debates around the country:

1. In most big cities there aren't enough good schools for all children

2. People who live near good schools support a policy of sending children to local schools, and people who don't live near good schools support policies that allow children and their families to choose to go to more distant schools.

"Mario Macis, Nicola Lacetera, and Bob Slonim, the authors of the most important work on this subject (references below), write to me with the details:

The decision to donate blood involves complex motivations including altruism, civic duty and moral responsibility. As a result, we agree with Buttonwood that in theory incentives could reduce the supply of blood. In fact, this claim is often advanced in the popular press as well as in academic publications, and as a consequence, more and more often it is taken for granted.

But what is the effect of incentives when studied in the real world with real donors andactual blood donations?

We are unaware of a single study of real blood donations that shows that offering an incentive reduces the overall quantity or quality of blood donations. From our two studies, both in the United States covering several hundred thousand people, and studies by Goette and Stutzer (Switzerland) and Lacetera and Macis (Italy), a total of 17 distinct incentive items have been studied for the effects on actual blood donations. Incentives have included both small items and gift cards as well as larger items such as jackets and a paid-day off of work. In 16 of the 17 items examined, blood donations significantly increased (and there was no effect for the one other item), and in 16 of the 17 items studied no significant increase in deferrals or disqualifications were found. No study has ever looked at paying cash for actual blood donations, but several of the 17 items in the above studies involve gift cards with clear monetary value.

By

"A typical hire is something that a department has prepared for at length and according to a familiar rhythm: asking to search, reading folders and conducting multiple campus interviews. By the time an offer is tendered, department members have had numerous opportunities to review the new hire’s credentials, hear the person give a talk, and even speak one-on-one. In contrast, a partner’s hire is often conducted more rapidly and with fewer opportunities for interaction with department members.

"In consequence, when the second partner starts his or her job, there may be fewer members of the department than usual who are aware that the hire has happened, let alone who are aware of academic interests they may have in common."

Saturday, October 6, 2012

One of the markets that the internet seems likely to change profoundly is the market for custom clothing. Bloomberg news had a recent report on what looks like it could be a small beginning of a big thing:

"Custom clothing startupsJ. Hilburn Inc.,American GiantandBonobos Inc.are racing to gain share in a U.S. e-commerce market that Forrester Research Inc. estimates will reach $327 billion in 2016, up from $202 billion last year. They’ve won customers and venture backers by cutting stores from the supply chain to ship straight to consumers from the factory, charging lower prices than department stores and eking out higher margins than Amazon.com Inc. , the biggest Web retailer.

“J. Hilburn will sell shirts that are made out of the same fabric mill in Italy that a Zegna would sell at Neiman Marcus for $300,” said Brian O’Malley, a partner at Battery Ventures, an investor in the startup, which has raised a total of about $12 million. “They can sell that same shirt totally custom-made for the customer for less, and do that still with healthy margins because there are a lot less middlemen along the way who need to get paid.”

Friday, October 5, 2012

"Mainstream publishing is a Rube Goldberg machine of perverse economic incentives, in which large numbers of mostly idiotic self-help guides, diet books, and airport thrillers subsidize an ever-shrinking number of mostly money-losing literary novels and books of poetry. But just because publishing operates on a crazy economic model doesn’t mean it doesn’t make sense. There is a market, however tiny, for good books, and there are a small number of smart, hard-working people who live for the thrill of finding a talented author. If you are one of those talented authors, then it is your job to stop whining and figure out how to make it easy for them to find you."

Abstract
"In this paper, we estimate the influence of social relationships on educational attainment and social outcomes of students in school. More specifically, we investigate how losing different types of social relationships during the transition from elementary to middle school affect students' academic progress and general well-being. We use social relationships identified by the students themselves in elementary school, as part of a unique aspect of the Tel Aviv school application process which allows sixth-grade students to designate their middle schools of choice and to list up to eight friends with whom they wish to attend that school. The lists create natural “friendship hierarchies” that we exploit in our analysis. We designate the three categories of requited and unrequited friendships that stem from these lists as follows: (1) reciprocal friends (students who list one another); and for those whose friendship requests did not match: (2) followers (those who listed fellow students as friends but were not listed as friends by these same fellow students) and (3) non-reciprocal friends (parallel to followers). Following students from elementary to middle school enables us to overcome potential selection bias by using pupil fixed-effect methodology. Our results suggest that the presence of reciprocal friends and followers in class has a positive and significant effect on test scores in English, math, and Hebrew. However, the number of friends in the social network beyond the first circle of reciprocal friends has no effect at all on students. In addition, the presence of non-reciprocal friends in class has a negative effect on a student’s learning outcomes. We find that these effects have interesting patterns of heterogeneity by gender, ability, and age of students. In addition, we find that these various types of friendships have positive effects on other measures of well-being, including social and overall happiness in school, time allocated for homework, and whether one exhibits violent behavior."

The paper uses the submitted friendship links, and the outcome of the school matching process, but doesn't give any indication of how the school choice process attempts to take into account the friendship links...

"Though some form of arranged marriage remains the most common way for Pakistanis to find spouses, marriage without the consent of a woman’s guardian was legalized in 2003. The change in the law has created a larger opening for many women to claim their independence, using the courts and the local news media.
...
"The tactics have given more visibility to a problem long considered largely a private matter.

“Things are changing; the girls are becoming bolder, they are continuously taking steps, and they are not afraid to die,” said Mahnaz Rahman, resident director of the Aurat Foundation, a women’s rights organization active throughout Pakistan. “They know that they will be killed, but even then they are taking these steps because they can’t conform to the values of their parents. They are the girls of this modern age.”

"When a woman disagrees with her parents’ choice of husband, she has few options, Ms. Rahman said. If she wants to marry someone else, the two must elope and leave the family home behind. By leaving the home, though, the daughter is considered to have dishonored her family, and that is where culture, custom and the legal system intersect with retribution.

"Parents frequently press kidnapping charges to regain control of a renegade daughter. Such cases can engulf entire families, as the police will often seize property and detain relatives of the accused man."

Tuesday, October 2, 2012

Boston's school choice system is presently organized intro districts, and parents can submit preferences for schools in their district (which are the processed in a deferred acceptance algorithm).

There have been concerns about transportation costs and times, and several new proposals are now under consideration, ranging from local schools to increasing the number of school districts, so that each one is smaller. (Here's the BPS page on the proposals and the public discussions that will now take place.)

Changing back to 100% local schools determined by home address would of course remove the need for any algorithm to process preferences. However all the other proposals will continue to need a school choice algorithm. As far as I know, there isn't any discussion about changing the algorithm, it's all about re-defining the choice sets.

Richmond, Va. - The OPTN/UNOS Kidney Transplantation
Committee is seeking public comment regarding substantial proposed amendments to
OPTN deceased donor kidney allocation policy. The proposed policy would maintain
access to kidney transplantation for all candidates while seeking to improve
outcomes for kidney transplant recipients, increase the years recipients may
have a functioning transplant and increase utilization of available kidneys.Matching to increase benefit and
utilizationMore than 93,000 people are currently listed for kidney
transplantation nationwide. About 10 percent of those candidates die each year
while waiting. Because there are not enough kidneys donated to meet the need, it
is important to improve benefit by matching recipients according to the
potential function of the kidney and ensure as many kidneys as possible are
transplanted.
The proposed policy includes new factors not used in the current policy.
Their use is recommended to enhance survival benefit and use of available
kidneys.

Kidney Donor Profile Index (KDPI)The
proposed policy would replace the existing policy definitions of "standard
criteria" and "expanded criteria" donors with the Kidney Donor Profile Index
(KDPI). KDPI is a clinical formula to classify kidney offers based upon the
length of time they are likely to continue to function once transplanted. This
index is already in use as a resource for transplant professionals to evaluate
kidney offers made under the current policy.

Estimated Post-transplant Survival
(EPTS)The proposed policy would separately employ a clinical formula
to estimate the number of years each specific candidate on the waiting list
would be likely to benefit from a kidney transplant. This score is called the
Estimated Post-transplant Survival formula (EPTS).
For more information about KDPI, EPTS and current policy definitions of
"standard" and "expanded criteria" donors, read
the frequently asked questions (FAQ) document.KDPI and EPTS matchingUnder the proposed
policy, KDPI and EPTS would be combined so that the 20 percent of kidney offers
with the longest estimated function determined by the KDPI would first be
considered for the 20 percent of candidates estimated by the EPTS to have the
longest time to benefit from a transplant. This policy revision is expected to
create significant benefit in terms of overall "life-years" (time that
recipients retain kidney function after the transplant). This improvement in
utilization of the limited number of donated deceased kidneys may reduce
recipients' future need for repeat transplants, thus allowing more transplants
among candidates awaiting their first opportunity.

For the remaining 80 percent of transplant candidates, the organ offer
process would be much the same as the existing system unless they receive
additional priority based on other considerations addressed below.

Promoting greater utilizationThe 15
percent of kidney offers estimated to have the shortest potential length of
function based on KDPI score would be offered on a wider geographic basis.
Similar to the use of currently defined "expanded criteria donor" kidneys, these
offers may be considered for candidates who would have a better life expectancy
with a timely transplant than they would remaining on dialysis. This feature is
expected to increase utilization of donated kidneys currently available for
transplant. It may also help minimize differences in local transplant waiting
times across different regions of the country.
...

Providing comment/process for further
consideration The full proposal is available on the OPTN
website. Anyone who has an interest may submit comments or questions on this
or other current proposals

***********
And below is an email from the committee chair, John Friedewald in reply to a query on a list-serve (reproduced here with his permission).

"The current proposal for kidney
allocation from the UNOS kidney committee is what it is not because it was the
first thing we thought of, and “wow, it’s perfect” but rather it is the product
of 8 years of trial and error, consensus building, and compromise. To
state that EOFI takes into account both equity and efficiency would seem to
suggest that the current UNOS proposal does not. How could this be?
We have tried over 50 different methods of allocation and simulated them
(which has not happened yet with EOFI). And with each simulation, we view
the results and how the system affects all sorts of different groups (NOT just
age, but blood type, ethnic groups, sensitized patients, the effects on organ
shipping, the effects on real efficiency in the system (the actual
logistics). And we have seen that some methods of allocation can generate
massive utility (or efficiency in your terminology). We can get thousands
of extra life years out of the current supply of organs. But in each
instance, we have made concessions in the name of equity. The current
proposal does not increase or decrease organs to any age group by more than 5%
(compared to current). This has been our compromise on equity.
What we see in utility/efficiency is an extra 8000+ years lived each year with
the current supply of organs. So the current policy has done a tremendous
amount to balance equity and utility. And we have left thousands of life
years lived on the table in the name of equity. Now you may argue that we
have not done enough in that regard, but rest assured, we have given equity
hundreds of hours of consideration.

"In terms of the possible changes
to living donor kidney transplant rates, we have to understand why there is concern.
The current “Share 35” plan prioritizes kidneys from donors under age 35 to
pediatric candidates. Because there are so few pediatric candidates in
any area, they tend to have very short waiting times compared to adult
candidates (months vs. years). And so, when faced with the decision, a
pediatric candidate can be fairly sure to get a high quality deceased donor
kidney in a relatively short period of time. So why take a kidney away
from a living donor? And so the argument goes. Pediatric candidates
will maintain their priority in the new system. And in fact, may have
even better organs, because Share 35 will now relate to KPDI rather than donor
age alone, a better marker of kidney longevity (some kidneys from donors under
35 aren’t that great, but KPDI tends to look at more factors than just age and
really get to kidney quality). So I would expect that many pediatric
candidates will still take a kidney from a deceased donor rather than a living
donor. The living donor kidneys would still often be predicted to last
them longer, but there is the issue of the risk to the living donor to consider
in that difficult equation.

With adults, it will be quite
different. The new proposal would prioritize kidneys from donors with a
KDPI < 20 (the “longest lasting” 20% of organs) to candidates with the 20%
longest estimated post-transplant survival (EPTS). This is done primarily
to avoid extreme mismatches in donor and recipient longevity. Why
20%? There are several reasons. First, the equations we use to
predict EPTS are not perfect (nor could they ever be). But it turns out,
the EPTS prediction is much better at the tails than it is in the middle.
So we are pretty good at picking out the ones at the far left of the
curve. And 20% was chosen because the EPTS curve changes slope around
that point. And 20% is a round number (we could have chosen 17% or 23%,
but that would even confuse people more – and we have heard over and over, “it
can’t be confusing”. The EPTS calculation was made simpler in response to
public feedback.). So the concern that I have heard is that if you are a
candidate in the top 20% EPTS, then you will get a great kidney right away, and
why would you take a living donor kidney? Just like the kids. But the
important difference here is in the numbers. Given 92,000 patients on the
wait list, there will be about 18,400 candidates in the “top 20%” EPTS
group. Now they will have priority (after multi-organ, after pediatrics,
after zero mismatches, after previous live donors) for those organs, but
remember, we only perform 11,500 or so transplant a year. So the top 20%
would be 2300 organs a year (assuming there are no pediatric, multi-organ
transplants done). So it is likely that candidates in the top 20 might
wait years (longer than candidates in the bottom 80 EPTS would wait for a
kidney in fact) for a top 20% kidney. That is why top 20 EPTS candidates
are eligible for all kidneys, because in practice, many of them will accept an
offer from a donor with KDPI > 20%. And guess what? They have to
wait JUST AS LONG for those as every other candidate. So we are not
really advantaging that top 20% group as much as people might think. But
we are trying to keep those really long lived organs for those who stand to
benefit from them a long time. And by doing that, we can realize all
those extra life years lived. And possibly decrease returns to the
waitlist (which benefits all candidates indirectly). We think that has to
be worth some tradeoffs. We have given careful thought and consideration
to those issues.

"Thanks for listening (reading),
and we really appreciate all the interest in the proposal. I just want to
make sure we are all talking about the same set of facts.